Provider Demographics
NPI:1669480745
Name:AHMED, PARVEEN NUR (MD)
Entity type:Individual
Prefix:
First Name:PARVEEN
Middle Name:NUR
Last Name:AHMED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2134
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-8034
Mailing Address - Country:US
Mailing Address - Phone:562-695-2282
Mailing Address - Fax:562-695-7252
Practice Address - Street 1:4511 ROSEMEAD BLVD
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-2032
Practice Address - Country:US
Practice Address - Phone:562-695-2282
Practice Address - Fax:562-695-7252
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40390207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A403900Medicaid
CAA40390Medicare PIN
CA00A403900Medicaid